epilepsy and pregnancy

Question 1

risks

Answer 1

increased risk of teratogenicity ass. w/ anti-epileptic drugs (AEDs)
moreso if taken in 1st trimester or more than 1 AEDs taken

lamotrigine increasingly prescribed in place of older AEDs such as carbamazepine and sodium valproate

once unplanned pregnancy discovered it is usually too late to change epilepsy regimen
risk of harm to mother and baby from convulsive seizures > than the risk of continuing medication

Question 2

contraception

Answer 2

cytochrome p-450 induction reduces the efficacy of the COCP, patch, vaginal ring and POP
efficacy of emergency contraception (levonorgestrel, possibly ulipristal) reduced in women taking enzyme-inducing drugs
copper IUD can be used instead

Question 3

fertility

Answer 3

may be reduced (poor evidence)
higher incidence of menstrual irregularities, PCOS and reproductive enzyme disorders
valproate therapy linked with polycystic ovaries and hyperandrogenism

Question 4

congenital abnormalities

Answer 4

increased
valproate is ass. w/ the highest risk - in particular neural tube defects and long term neuro development effects
do not use valproate in pregnancy or in women of childbearing age unless no other option, and then with careful discussion of the risks
topiramate linked to cleft palate if taken in the 1st trimester

Question 5

fetal anticonvulsant syndrome

Answer 5

valproate leads to more distinctive facial features:

upturned nose, mild mid facial hypoplasia, long upper lip, thin vermillion border

Question 6

antenatal care

Answer 6

concentrations of plasma AEDs can change during pregnancy
women who present with seizures in the second half or pregnancy should be assessed for pre-eclampsia before any change is made to AEDs
care should be shared between consultant obstetrician and epilepsy specialist
status carries a higher risk or mortality for mother and fetus
generalised seizures occurring during labour can lead to fetal bradycardia

Question 7

increased risks

Answer 7

increased risk of:
hyperemesis gravidarum
gestational HTN
mild pre-eclampsia
vaginal bleeding
anaemia

premature labour
failure to progress
increased rate of C-sections

breastfeeding is safe
doses may need reducing if they were increased during pregnancy